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At least 19 recordsLinked to original sources
PubMed1989

Otoscopic diagnosis of middle ear effusion in acute and non-acute otitis media. I. The value of different otoscopic findings.

To determine the value of different pneumotoscopic findings in diagnosing the middle ear effusion (MEE) of acute (AOM) and non-acute otitis media, 11,804 ear-related visits of 2,911 unselected children at ages 0.5-2.5 years were analysed. About half of these were examined by an otolaryngologist in one, and half by a pediatrician in another, urban area. Myringotomy was always performed when MEE was suspected, and it confirmed the presence of MEE in 85% (otolaryngologist) and 82% (pediatrician) of altogether 5,462 acute and in 69% (both doctors) of 1,092 non-acute cases suspected. Redness of the tympanic membrane (TM) was found in only 18% and 27% of the visits with AOM, and it predicted MEE with only 60% and 51% probability, if seen in acute visits. Cloudiness of the TM was noticed in 81% and 67% of the visits with AOM; its specificity and the other calculated variables were good in regard to the diagnosing of MEE, especially in acute cases in both groups. Distinctly impaired mobility of the TM was of about the same diagnostic value, but its position reliably indicated MEE only when bulging. In AOM the colour or mobility of the TM was normal very rarely, but the position was normal in a third of the cases. Thus, although there were differences in the incidences of different otoscopic findings in the two study groups, the diagnostic value of certain pneumatic otoscopic findings, especially cloudiness and distinct hypomobility of the TM, seemed to be good in both groups.

Acute Disease↗
PubMed1993

Abnormalities of the neonatal ear: otoscopic observations, histologic observations, and a model for contamination of the middle ear by cellular contents of amniotic fluid.

It is unknown whether childhood ear disease could be present long before symptoms provoke an initial otoscopic examination. A newborn middle ear might or might not start in a pristine, privileged state. The clinician evaluating later infant and childhood ear disease is often unaware of the status of a patient's ear from the neonatal period, the earliest time at which the tympanic membrane can be evaluated. Adding to the physician's handicap, normative otoscopic and histologic data on the neonatal ear are incomplete. In order to test the hypothesis that disease in the neonatal middle ear may be more common than is generally appreciated, the population of critically ill neonates was selected for study since this group can provide both clinical as well as histologic data. This manuscript is divided into three parts. Clinically, otoscopic observations were analyzed on infants in an intensive care unit. Histologically, neonatal temporal bones were studied for normal anatomy and pathology of the middle ear and antrum. Experimentally, an animal study was performed to evaluate the potential effect of amniotic fluid cellular contents aspirated into the middle ear. I. Clinical Otoscopic Observations. Daily otoscopic examination was conducted on 44 neonates in an intensive care unit. Specific parameters of the otoscopic examination were evaluated to compare with the normal, translucent tympanic membrane of the older child. The otoscopic appearance was found to be abnormal in 97.7% of neonatal ears. Of the otoscopic parameters evaluated, right ears averaged 2.6 abnormalities and left ears averaged 2.5 otoscopic abnormalities. The otoscopic appearance of the neonate in the neonatal intensive care unit is nearly universally abnormal. II. Temporal Bone Histologic Observations. One hundred eleven temporal bones from 56 neonates were collected for histologic study by light microscopy. Mesenchyme filling more than 60% of the middle ear space was found in 13 bones. Amniotic fluid cellular content was detected in 90 bones. Purulent otitis media was detected in 24 bones. Varying amounts of blood were found in the middle ear space of 34 bones. Only 7 of the bones had no significant middle ear abnormality. It is concluded that in the critically ill neonate, the middle ear and antrum usually contain cellular or fluid material, often in significant volume, that would not be considered normal in the older patient. III. An Animal Model Simulating Contamination of the Middle Ear by Cellular Contents of Amniotic Fluid.(ABSTRACT TRUNCATED AT 400 WORDS)

Amniotic Fluid↗
PubMed2003

Evaluation of video-otoscopes suitable for tele-otology.

The objectives of this study were to assess the quality of digitized video-otoscopes as well as its ease of use and safety. Four video-otoscopes available in Australia were used to image 96 patients. At least 22 patients (age range 5-70 years) were imaged with each video-otoscope, and the images were stored in a JPEG format. Three experienced otolaryngologists assessed all images for quality, clarity, color accuracy, orientation of eardrum and therefore ability to make a definitive diagnosis. The grading was a five-level scale: poor, adequate, good, very good and excellent. Two telescope systems produced high quality images (>80% were adequate or better), essential for accurate diagnosis, but both were associated with increased risk for injury in unskilled hands. The MedRx video-otoscope produced high-quality images (87% were adequate or better), while the Welch Allyn Compact Video-otoscope produced poor image quality (only 40% were adequate or better). Both devices were seen to be safer to use than the telescope systems. The telescope systems and MedRx otoscope provided optimum quality images necessary for tele-otology. However, the telescope units were considered to be unsafe in unskilled hands. The MedRx can be recommended as a safe device producing high-quality images.

Adolescent↗
PubMed1997

Stethoscopes and otoscopes--a potential vector of infection?

OBJECTIVES: We aimed to determine whether stethoscopes and otoscopes used in community paediatric clinics harboured pathogenic micro-organisms, and, if so, which measures could prevent this. METHODS: Fifty-five stethoscopes belonging to paediatric physicians working in 12 community clinics were sampled for bacterial cultures by two methods: (i) direct impression of the diaphragm and bell section of each stethoscope for 5 seconds onto blood agar plates and a mannitol-salt-agar plate; (ii) swabbing the entire surface of the diaphragm of the stethoscope with a sterile cotton-tipped applicator. Forty-two otoscopes from the same physicians were sampled by rubbing the handles of the otoscopes with cotton-tipped swabs. The plates were incubated at 37 degrees C for 48 hours and examined for colony growth at 24 and 48 hours of incubation. Culture results were recorded as mean numbers of colony-forming units (CFUs). Eight additional stethoscope diaphragms were chosen at random at the participating clinics and cultured as described above. They were then wiped with alcohol swabs (isopropyl alcohol 70%), allowed to air dry for approximately 10 minutes and cultured a second time. RESULTS: All the stethoscopes and 90% of the otoscope handles were colonized by microorganisms. Staphylococci were isolated from 85.4% of the stethoscopes and 83.3% of the otoscopes, with 54.5% and 45.2% respectively being S. Aureus. Methicillin-resistant S. aureus were found in four each of the stethoscopes (7.3%) and otoscopes (9.5%). Cleaning with alcohol reduced the colony count by an average of 96.3%. CONCLUSIONS: Fomites can harbour potentially pathogenic bacteria, and with the increasing trend for children with more complex medical problems to be managed in an ambulatory setting, often by physicians who also work in hospitals, there is a real risk of spreading potentially serious infections to such patients. Simple cleansing with alcohol effectively eliminates the bacterial contamination of the fomites, and should be encouraged.

Community Health Centers↗
PubMedDate not supplied

A needle otoscope. An instrument of endotoscopy of the middle ear.

A side-viewing needle otoscope, which facilitates visual inspection of the inside of the middle ear, has been devised. The instrument consists of a Selfoc rod lens for observation and a glass fiber bundle for illumination. Prisms, attached to the tip of the lens and the glass fiber bundle, facilitate the examination of a 90 degrees lateral region within the middle ear cavity. Through an existing eardrum perforation, the tip of our otoscope is safely introduced into the middle ear by using a self-illuminating otoscope. The ossicles and walls of the tympanic cavity are clearly visualized. The instrument facilitates locating lesions and diagnosing middle ear diseases. Our otoscope can be used without anesthesia in the outpatient clinic, as well as during surgery. By videotape recording, the image can be used in determining the clinico-pathological situations. As the view presented by our otoscope differs from the routine one, the anatomy of the middle ear structures must be conceptualized differently before clinical application of our needle otoscope.

Ear Diseases↗
PubMed1996

Interexaminer reliability of otoscopic signs and tympanometric measures for older adults.

To accurately classify hearing loss and otic disorders among older adults, examiners must be able to consistently assess otoscopic signs and perform middle-ear screening tympanograms. As part of a population-based study of hearing loss in Beaver Dam, Wisconsin, the interexaminer reliability of otoscopic examinations and screening tympanograms was evaluated using 45 replicate examinations. Data from 1941 participants 48 to 91 years of age were used to compare otoscopic and tympanometric results. Overall agreement for nine otoscopic signs ranged from 73 percent (vascularity) to 100 percent (drainage). There were small examiner differences in tympanometric measures of equivalent ear-canal volume (Vea) and tympanogram width. No significant differences were observed for peak compensated static acoustic admittance and tympanogram peak pressure. Our findings suggest that examiners can be trained to consistently and accurately assess otoscopic signs and obtain reliable tympanometric results.

Acoustic Impedance Tests↗
PubMed2006

Evaluation of otoscope cone cleaning and disinfection procedures commonly used in veterinary medical practices: a pilot study.

The objective of this study was to evaluate the relative efficacy of otoscope cone cleaning and disinfection methods commonly used in veterinary practices. Using sterile technique, 60 new gas-sterilized 4-mm otoscope cones were inoculated with a broth culture of 1.5 billion Pseudomonas aeruginosa bacteria per mL then allowed to dry for 10 min. Six study groups of 10 cones each were created. Group 1 served as positive control and received no cleaning or disinfection. Group 2 cones were wiped with sterile cotton-tipped applicators and gauze then rinsed with water. Group 3 cones were wiped with 70% isopropyl alcohol. Group 4 cones were scrubbed in a speculum cleaner with Cetylcide II solution (Cetylite Industries, Inc., Pennsauken, NJ). Groups 5 and 6 cones were soaked for 20 min in Cetylcide II and chlorhexidine gluconate 2% solutions, respectively. Using sterile technique and after 10-15 min drying time, the cones were swabbed in a consistent pattern, and samples were submitted for quantitative culture. Culture results showed no growth from cones soaked in Cetylcide II or chlorhexidine solutions. Two of the 10 cones wiped with alcohol, 3/10 cones wiped then rinsed with water, and 3/10 cones scrubbed with the speculum cleaner showed growth of P. aeruginosa. All (10/10) cones in the control group showed heavy growth of P. aeruginosa. These results show that P. aeruginosa can survive on otoscope cones cleaned and disinfected by several commonly used methods. Further study is needed to determine practical and optimal cleaning and disinfection methods for otoscope cones.

Animals↗
PubMed1985

Reliability of a sound-generating otoscope.

A sound-generating otoscope was compared with standard audiometric testing. Subjects of different ages and with different auditory pathologies were examined. The sound-generating otoscope was found to agree 92.4% of the time. Errors occurred more often with subjects having normal hearing. No single frequency delivered by the otoscope produced a significantly higher error rate than had been reported by other investigators. The otoscope can also be used to detect collapse of the external auditory meatus that might occur during regular audiometric testing.

Adolescent↗
PubMed1992

Assessment of otoscopists' accuracy regarding middle-ear effusion. Otoscopic validation.

Validation of otoscopic diagnostic accuracy is an important aspect of medical education and is necessary to substantiate clinical research observations. In addition, otoscopic accuracy is a prerequisite to optimal patient care. We describe an otoscopic validation program at the Children's Hospital of Pittsburgh (Pa) in which 27 physicians and three nurse practitioners participated from December 1980 to March 1990. The lowest acceptable limits for sensitivity and specificity regarding the diagnosis of middle-ear effusion were arbitrarily set at 80% and 70%, respectively. The 30 participating clinicians examined a total of 4147 ears. Mean sensitivity and mean specificity for the group as a whole were 87% and 74%, respectively. The chief benefit of the program was an improvement in diagnostic skills for some individuals. The chief limitation was the large amount of time required. We conclude that a formal validation program can document achievement of a reasonable standard of otoscopic diagnostic accuracy.

Child↗
PubMed2004

Otoscopic evaluation of the ear canal.

Otoscopic evaluation of the external ear canal and tympanic membrane is the first diagnostic procedure that should be performed in animals presented with otitis externa. It is important to become familiar with the normal structures of the ear to identify any abnormalities. The video otoscope greatly enhances visualization of these structures as well as aiding in retrieval of foreign bodies, biopsy of masses, and performance of a myringotomy. In some cases, a complete otoscopic examination is not possible on the first visit, and the animal may require anti-inflammatory medications or otic flushing to visualize the entire ear canal as well as the tympanic membrane. The purpose of the otoscopic examination is to address the otitis by evaluating the condition of the ear, looking for any masses or foreign bodies; noting the presence, consistency, and color of any exudate; and evaluating the patency of the tympanic membrane. Once a complete otic evaluation has been performed, additional diagnostics as well as a treatment plan can be formulated.

Animals↗
PubMed2004

Otoscopic and tympanometric findings in acute otitis media yielding dry tap at tympanocentesis.

BACKGROUND: The value of tympanometry in detection of middle ear effusion (MEE) has been widely studied in otitis media with effusion. There has been no direct comparison of tympanometric and tympanocentesis (TAP) findings in acute otitis media (AOM). We compared otoscopic, tympanometric and TAP findings in AOM including cases of AOM without effusion. METHODS: In a study of AOM treatment of 90 children, a tympanogram was obtained, and TAP was performed before and after 5 days of treatment. Subjects were followed with otoscopy and tympanometry every 2 weeks for 3 months or until the MEE cleared. RESULTS: In 130 AOM ears, otoscopic, tympanometric and TAP findings were available; MEE was obtained from 110 ears. Of 20 ears with a dry tap, 18 had abnormal tympanogram and otoscopic findings. With TAP findings as the standard, sensitivity and positive predictive value of type B tympanogram were 97 and 87%, respectively. Of 18 AOM ears yielding dry tap, 2 yielded MEE 5 days later, and 8 continued with evidence of MEE 5 days-12 weeks later. Five subjects with 8 AOM ears yielding dry tap were lost to follow-up; all had short duration of clinical symptoms. CONCLUSIONS: Although otoscopic and tympanometric findings suggested the presence of MEE in AOM, MEE was unobtainable by TAP in 14% of cases. Dry tap cases likely represent early AOM before accumulation of detectable MEE. However, technical difficulty in obtaining small amounts of or highly viscous MEE could not be excluded. Sensitivity and positive predictive value of abnormal tympanograms in detection of MEE in AOM cases are comparable with those in otitis media with effusion.

Acoustic Impedance Tests↗
PubMed2006

Otoscopic, cytological, and microbiological examination of the equine external ear canal.

Otoscopic examination and cytology of the equine ear would be beneficial in diseases such as head trauma, headshaking, otitis externa secondary to otitis media, vestibular disease, aural neoplasia and aural pruritus secondary to parasites. In practice, otic examinations of horses are rarely done due to the perceived difficulty in visualizing the equine external ear canal and tympanic membrane, as well as the need for chemical restraint. In this study, the proximal external ear canal was examined in live horses using a handheld otoscope and in cadaver heads using video otoscopy. Visualization of the proximal ear canal of the sedated horse could be done with a handheld otoscope, but more sedation or general anaesthesia and a video otoscope would be required to adequately visualize the tympanic membrane in the live horse. The proximal ear canals of 18 horses were examined cytologically and cultured aerobically. In three horses, both ears were sampled. No cells or organisms were seen on cytological examination of 11/21 ears. Nine of the 21 ears were sterile when cultured. Ten of the 21 ears had mixed growth with low numbers of organisms (Corynebacterium sp. being most common). Two of the 21 ears had heavy growth of a single organism (Corynebacterium sp. and Staphylococcus intermedius, respectively). Equine cadaver heads were examined in cross-section by computed tomography (CT) imaging and histopathology in order to further understand the anatomy of the equine external ear canal. Equine practitioners should be aware that otic examination is possible and may provide important diagnostic information.

Animals↗
PubMedDate not supplied

Latent class analysis: an illustrative application for education in the assessment of resident otoscopic skills.

BACKGROUND: There is no gold standard readily available in several components of the routine physical exam: one example is the otoscopic exam, where the gold standard is confirmation by tympanocentesis. Resident education does not typically include routine assessment by the gold standard, making estimates of trainee performance extremely difficult. This is one reason why the otoscopic examination is difficult to teach. Available techniques can assess diagnostic exams when there is no gold standard-one of these is latent class analysis. METHODS: We use latent class analysis, a form of regression analysis, to compare the ability of pediatric residents to diagnose effusion with pediatric otolaryngologists and tympanometry. We briefly outline the technique of how to complete latent class analysis and provide an operational plan to use the method to assess resident performance. RESULTS: The sensitivity and specificity of pediatric resident otoscopic examination to diagnose the presence of effusion was 72% and 84%, respectively. Pediatric otolaryngologist sensitivity and specificity was 91% and 82%; tympanometry had a sensitivity of 70% and specificity 76%. Our estimates of the performance of otolaryngologists and tympanometry to diagnose effusion were the same as previously reported when these diagnosticians have been compared with the gold standard of tympanocentesis. CONCLUSIONS: Latent class analysis can help estimate otoscopic examination performance of residents. This technique can be incorporated into assessment in medical education.

Acoustic Impedance Tests↗
PubMed1994

Use of the otoscope in the evaluation of common injuries and illnesses of the ear.

Ear injuries and/or illnesses make up only a small percentage of the total injuries seen by the athletic trainer. However, if these conditions are left undetected or untreated, permanent ear damage could result. Many ear injuries involve structures that can only be viewed through the use of an otoscope. Although more athletic trainers are using the otoscope to evaluate the ear, there is little documentation available in athletic training literature regarding its proper use. This article describes the proper use of the otoscope in evaluating the ear and discusses the common pathological conditions that might confront the athletic trainer. This article will provide a resource that can be used in conjunction with the guidance of your team physician to help you develop the knowledge and skills required for performing an otoscopic examination.

Journal Article↗
PubMed2000

Otoscopic findings in relation to tympanometry during infancy.

To determine the value of different otoscopic findings in diagnosing otitis media with effusion, 3,780 otological examinations of 250 infants at ages 0-2 years were compared with tympanometric findings. Otoscopy was performed by an experienced otologist and research-audiologist prior to tympanometry. The following success rates for these procedures were found: otoscopy, 85-91%, tympanometry, 74-94%, either otoscopy or tympanometry, 89-99%. "Glue" was noted as the most frequent abnormal otoscopic feature, i.e., depending on age, 6-32%. Fluid line/ bubbles, bulging/hyperaemia or otorrhoea were rarely (0-5%) observed and contributed little to the diagnosis of otitis media with effusion. No structural changes of the tympanic membrane were observed. Analysis of tympanometric data revealed that the prevalence of tympanogram types B (21-44%), C1 (0.5-16%) and C2 (0-8%) was age-dependent. Comparison of otoscopic and tympanometric findings indicated sufficient diagnostic agreement (Cohen's kappa between 0.41 and 0.74) at age 6-24 months. In conclusion, otoscopy appears to be a valid instrument for diagnosing otitis media with effusion, at least from 6 to 24 months of age. In addition, the results of our study suggest that tuba-dysfunction and otitis media with effusion are age-dependent disorders during infancy, without structural effects on the tympanic membrane.

Acoustic Impedance Tests↗
PubMed2003

A comparison of in-person examination and video otoscope imaging for tympanostomy tube follow-up.

The objective of this study was to determine if video otoscope still images (640 x 480 pixel resolution) of the tympanic membrane following surgical placement of tympanostomy tubes are comparable to an in-person microscopic examination. Forty patients having undergone tympanostomy tube placement in both ears were independently examined in-person by two otolaryngologists and imaged using a video otoscope and telemedicine software package. The two physicians later reviewed images at 6 and 12 weeks. Physical examination findings and diagnosis were documented and compared for their concordance using kappa statistics. For both physicians, the intraprovider concordance between the in-person examination and the corresponding image review was high for each of the physical examination findings: Tube In 93-94% (K 0.85-0.87), Tube Patent 86-93% (K 0.74-0.85), Drainage 94-98% (K 0.42-0.66), Perforation 85-98% (K 0.40-0.84), Granulation 95-99% (K -0.01 to 0.00), Middle Ear Fluid 89-91% (K -0.03 to 0.50), and Retracted 89-94% (K 0.13-0.43). These agreement rates are similar to the normal interprovider concordance observed when two physicians independently examined the same patient in-person for physical exam findings: Tube In 96% (K 0.93), Tube Patent 94% (K 0.88), Drainage 96% (K 0.56), Perforation 90% (K 0.60), Granulation 96% (K 0.39), Middle Ear Fluid 88% (K 0.14), and Retracted 91% (K 0.43). For both physicians, the intraprovider diagnostic concordance between the in-person examination and the corresponding image review was high 79-85% (K 0.67-0.76). The interprovider diagnostic concordance for the in-person exam was 88% (K 0.81). The interprovider diagnostic concordance when two physicians independently reviewed all images was 84% (K 0.74), and 89% (K 0.80) when poor images were excluded. This study demonstrates that physician review of video otoscope images is comparable to an in-person microscopic examination. Store-and-forward video otoscopy may be an acceptable method of following patients post-tympanostomy tube placement.

Adolescent↗
PubMed1998

Historic perspective of the acoustic otoscope.

The acoustic otoscope, originally called the acoustic reflectometer, was developed and produced by John and David Teele in the early 1980s. Since initial production, two different instrument versions have been developed by two separate companies. During the period of time in which the acoustic otoscope has been in production, there have been numerous studies reported with the two instrument versions. We provide a historic summary of the acoustic otoscope, summarize the pertinent studies, and address the contrasting results found in the literature.

History, 20th Century↗